Editing Tooth decay (section)

===Other measures===
[[File:FluorideTrays07-05-05.jpg|thumb|alt=Refer to caption|Common dentistry trays used to deliver fluoride]]
[[File:Sodium fluoride tablets.jpg|thumb|Fluoride is sold in tablets for cavity prevention.]]
The use of [[dental sealant]]s is a means of prevention.<ref>{{cite journal |vauthors=Mejare I, Lingstrom P, Petersson LG, Holm AK, Twetman S, Kallestal C, Nordenram G, Lagerlof F, Soder B, Norlund A, Axelsson S, Dahlgren H |year=2003 |title=Caries-preventive effect of fissure sealants: a systematic review |journal=Acta Odontologica Scandinavica|volume=61 |issue=6|pages=321–330 |doi=10.1080/00016350310007581|pmid=14960003 |s2cid=57252105 }}</ref> A sealant is a thin plastic-like coating applied to the chewing surfaces of the molars to prevent food from being trapped inside pits and fissures. This deprives resident plaque bacteria of carbohydrate, preventing the formation of pit and fissure caries. Sealants are usually applied on the teeth of children, as soon as the teeth erupt but adults are receiving them if not previously performed. Sealants can wear out and fail to prevent access of food and plaque bacteria inside pits and fissures and need to be replaced so they must be checked regularly by dental professionals. Dental sealants have been shown to be more effective at preventing occlusal decay when compared to fluoride varnish applications.<ref>{{Cite journal|last1=Ahovuo-Saloranta|first1=Anneli|last2=Forss|first2=Helena|last3=Hiiri|first3=Anne|last4=Nordblad|first4=Anne|last5=Mäkelä|first5=Marjukka|date=2016-01-18|title=Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents|journal=The Cochrane Database of Systematic Reviews|volume=2016 |issue=1|pages=CD003067|doi=10.1002/14651858.CD003067.pub4|issn=1469-493X|pmid=26780162|pmc=7177291}}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/33142363|date = January 2021}}

Calcium, as found in food such as milk and green vegetables, is often recommended to protect against dental caries. [[Fluoride]] helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel.<ref>[[#Nanci|Nanci]], p. 7</ref> ''Streptococcus mutans'' is the leading cause of tooth decay. Low concentration fluoride ions act as bacteriostatic therapeutic agent and high concentration fluoride ions are bactericidal.<ref>{{cite journal|last1=A|first1=Deepti|last2=Jeevarathan |first2=J|last3=Muthu|first3=MS|last4=Prabhu V|first4=Rathna|last5=Chamundeswari|date=2008-01-01|title=Effect of Fluoride Varnish on Streptococcus mutans Count in Saliva of Caries Free Children Using Dentocult SM Strip Mutans Test: A Randomized Controlled Triple Blind Study|journal=International Journal of Clinical Pediatric Dentistry|volume=1|issue=1|pages=1–9|doi=10.5005/jp-journals-10005-1001|issn=0974-7052|pmc=4086538|pmid=25206081}}</ref> The incorporated fluorine makes enamel more resistant to demineralization and, thus, resistant to decay.<ref>Ross, Michael H., Kaye, Gordon I. and Pawlina, Wojciech (2003). ''Histology: A Text and Atlas''. 4th edition, p. 453. {{ISBN|0-683-30242-6}}.</ref> Fluoride can be found in either topical or systemic form.<ref name="Takahashi-2015">{{Cite journal|doi=10.1002/14651858.cd011850|title=Fluoride supplementation in pregnant women for preventing dental caries in the primary teeth of their children|journal=Cochrane Database of Systematic Reviews|issue=8 |page=CD011850|year=2015|last1=Takahashi|first1=Rena|last2=Ota|first2=Erika|last3=Hoshi|first3=Keika|last4=Naito|first4=Toru|last5=Toyoshima|first5=Yoshihiro|last6=Yuasa|first6=Hidemichi|last7=Mori|first7=Rintaro|editor1-last=Mori|editor1-first=Rintaro|doi-access=free}}</ref> Topical fluoride is more highly recommended than systemic intake to protect the surface of the teeth.<ref>Limited evidence suggests fluoride varnish applied twice yearly is effective for caries prevention in children at {{cite web|url=http://ebd.ada.org/SystematicReviewSummaryPage.aspx?srId=876816cd-5f69-4bd5-b320-3502a1bbd8ea|title=ADA&nbsp;— EBD::Systematic Reviews|archive-url=https://web.archive.org/web/20131203023447/http://ebd.ada.org/SystematicReviewSummaryPage.aspx?srId=876816cd-5f69-4bd5-b320-3502a1bbd8ea|archive-date=2013-12-03|url-status=dead|access-date=2013-07-30}}</ref> Topical fluoride is used in toothpaste, mouthwash and fluoride varnish.<ref name="Takahashi-2015" /> Standard fluoride toothpaste (1,000–1,500 ppm) is more effective than low fluoride toothpaste (< 600ppm) to prevent dental caries.<ref>{{cite journal|last1=Santos|first1=A. P. P.|last2=Oliveira|first2=B. H.|last3=Nadanovsky|first3=P.|date=2013-01-01|title=Effects of low and standard fluoride toothpastes on caries and fluorosis: systematic review and meta-analysis|journal=Caries Research|volume=47|issue=5|pages=382–390|doi=10.1159/000348492|issn=1421-976X|pmid=23572031|s2cid=207625475}}</ref> It is recommended that all adult patients to use fluoridated toothpaste with at least 1350ppm fluoride content, brushing at least 2 times per day and brush right before bed. For children and young adults, use fluoridated toothpaste with 1350ppm to 1500ppm fluoride content, brushing 2 times per day and also brush right before bed. American Dental Association Council suggest that for children <3 years old, caregivers should begin brushing their teeth by using fluoridated toothpaste with an amount no more than a smear. Supervised toothbrushing must also be done to children below 8 years of age to prevent swallowing of toothpaste.<ref>{{Cite journal|date=February 2014|title=Fluoride toothpaste use for young children|journal=The Journal of the American Dental Association|volume=145|issue=2|pages=190–191|doi=10.14219/jada.2013.47|pmid=24487611|issn=0002-8177|author1=American Dental Association Council on Scientific Affairs|doi-access=free}}</ref> After brushing with fluoride toothpaste, rinsing should be avoided and the excess spat out.<ref>{{cite web|url=http://dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_102982.pdf|title=Delivering Better Oral Health: An evidence-based toolkit for prevention, second edition|date=April 2009|publisher=Department of Health / British Association for the Study of Community Dentistry|archive-url=http://webarchive.nationalarchives.gov.uk/20100810041346/http://dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_102982.pdf|archive-date=2010-08-10|url-status=dead}}</ref> Many dental professionals include application of topical fluoride solutions as part of routine visits and recommend the use of xylitol and [[amorphous calcium phosphate]] products. 

[[Silver diammine fluoride]] may work better than fluoride varnish to prevent cavities.<ref>{{cite web|url=http://www.sdcep.org.uk/wp-content/uploads/2013/03/SDCEP_PM_Dental_Caries_Full_Guidance1.pdf|title=Prevention and management of dental caries in children: Dental clinical guidance|date=April 2010|website=sdcep.co.uk|pages=6–7|archive-url=https://web.archive.org/web/20161005142226/http://www.sdcep.org.uk/wp-content/uploads/2013/03/SDCEP_PM_Dental_Caries_Full_Guidance1.pdf|archive-date=5 October 2016|url-status=live|access-date=7 March 2016}}</ref> Systemic fluoride is found as lozenges, tablets, drops and water fluoridation. These are ingested orally to provide fluoride systemically.<ref name="Takahashi-2015" /> 

[[Water fluoridation]] has been shown to be beneficial to prevent tooth decay, especially in low social economical areas, where other forms of fluoride not available. However, a Cochrane systematic review found no evidence to suggest that taking fluoride systemically daily in pregnant women was effective in preventing dental decay in their offspring.<ref name="Takahashi-2015" /> 

While some products containing chlorhexidine have been shown to limit the progression of existing tooth decay; there is currently no evidence suggesting that chlorhexidine gels and varnishes can prevent dental caries or reduce the population of ''Streptococcus mutans'' in the mouth.<ref>{{Cite journal|last1=Walsh|first1=Tanya|last2=Oliveira-Neto|first2=Jeronimo M|last3=Moore|first3=Deborah|date=2015-04-13|title=Chlorhexidine treatment for the prevention of dental caries in children and adolescents|url=https://doi.org/10.1002/14651858.CD008457.pub2|journal=Cochrane Database of Systematic Reviews|volume=2015 |issue=4|pages=CD008457|doi=10.1002/14651858.cd008457.pub2|pmid=25867816|issn=1465-1858|pmc=10726983}}</ref>

An oral health assessment carried out before a child reaches the age of one may help with management of caries. The oral health assessment should include checking the child's history, a clinical examination, checking the risk of caries in the child including the state of their [[Occlusion (dentistry)|occlusion]] and assessing how well equipped the child's parent or carer is to help the child prevent caries.<ref name="sdcep-2010" /> To further increase a child's cooperation in caries management, good communication by the dentist and the rest of the staff of a dental practice should be used. This communication can be improved by calling the child by their name, using eye contact and including them in any conversation about their treatment.<ref name="sdcep-2010">{{cite web|url=http://www.sdcep.org.uk/wp-content/uploads/2013/03/SDCEP_PM_Dental_Caries_Full_Guidance1.pdf|title=Prevention and management of dental caries in children: Dental clinical guidance|date=April 2010|website=sdcep.co.uk|pages=6–7|access-date=7 March 2016|url-status=live|archive-url=https://web.archive.org/web/20161005142226/http://www.sdcep.org.uk/wp-content/uploads/2013/03/SDCEP_PM_Dental_Caries_Full_Guidance1.pdf|archive-date=5 October 2016}}</ref>

[[Caries vaccine|Vaccines]] are also under development.<ref>{{cite journal|last=Russell|first=MW |author2=Childers, NK |author3=Michalek, SM |author4=Smith, DJ |author5=Taubman, MA|title=A Caries Vaccine? The state of the science of immunization against dental caries|journal=Caries Research|date=May–Jun 2004|volume=38 |issue=3|pages=230–5|pmid=15153693|doi=10.1159/000077759|s2cid=5238758 |doi-access=free}}</ref>